Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/66—Phosphorus compounds
  • A61K31/661—Phosphorus acids or esters thereof not having P—C bonds, e.g. fosfosal, dichlorvos, malathion or mevinphos
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/04—Anorexiants; Antiobesity agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
  • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics

Definitions

• the invention relates to lipid compositions and methods of using the lipid compositions for treatment of metabolic disorders, including diabetes and inflammatory bowel disease.
• the orphan nuclear receptor LRH-1/NR5A2 is expressed in the liver, intestine, exocrine pancreas, and ovary. It binds DNA as a monomer and is best known as a regulator of hepatic expression of the key bile acid biosynthetic enzyme Cyp7Al but is also reported to regulate expression of a number of other genes associated with bile acid and cholesterol homeostasis, as well as other metabolic targets. It is expressed in embryonic stem cells and initial stages of embryonic development. The very early lethality of LRH-I null mice both highlights its essential developmental role and precludes straightforward knockout studies that have been so useful for delineating the functions of other orphan and former orphan receptors.
• LRH-I receptor is potently activated by phosphatidylcholine lipids having 22-24 total carbons in their fatty acid tails. Specifically, we have shown that diundecanoyl (Cl 1 :0-C11 :0) and dilauroyl (C12:0-C12:0) phosphatidylcholine (PC), referred to as DUPC and DLPC, respectively are LRH-I agonists. Surprisingly, other PC lipids having different chain lengths and lipids with other head groups did not activate this receptor. Importantly, we also have discovered that administration of DUPC and DLPC to diabetic mice improves insulin sensitivity.
• LRH-I is a key metabolic regulator and that agonists such as DUPC and DLPC can have beneficial effects in treatment of metabolic disorders such as diabetes, as well other diseases linked to LRH-I receptor activity, such as inflammatory bowel disease.
• the invention features a composition including at least one (e.g., two, three, or four) phosphatidylcholine (PC) lipid(s) having 22, 23, or 24 total carbon atoms in its fatty acid tails (e.g., where the fatty acid tails each are 10, 1 1, 12, or 13 carbon atoms in length, such as the lipids described herein).
• PC phosphatidylcholine
• Particular lipids include those selected from the group consisting of diundecanoylphosphatidylcholine (DUPC), dilauroylphosphatidylcholine (DLPC), a Cl 1 :0, Cl 2:0 undecanoyl, lauroyl PC, a Cl 1 :0, Cl 3:0 undecanoyl, tridecanoyl PC, and a Cl 0:0, C12:0 decanoyl, lauroyl PC, or a combination thereof.
• the composition may be enriched.
• the lipid(s) may be present with a pharmaceutically acceptable carrier.
• the lipid(s) may be from about 0.01% to about 99% (e.g., from about 0.1% to about 50%) of the composition.
• the composition may contain at least 1, 5, 10, 25, 50, 100, 250, 500, or 750 ⁇ g; at least 1 , 2, 5, 10, 25, 50, 100, 250, 500, or 750 mg; or at least 1 , 2, 5, 10, 15, 20, 25, 50, 100, or 200 g of the lipid(s), or any range between these values.
• the composition may be in any pharmaceutically acceptable form described herein (e.g., a tablet or a liquid formulation).
• the composition is food supplemented with the lipid(s) (e.g., DUPC or DLPC).
• the lipid(s) may be present in the composition in an amount sufficient to treat a metabolic disorder (e.g., any described herein, such as diabetes) or inflammatory bowel disease.
• the lipid(s) are present in the composition in a non-liposomal form.
• the lipid(s) are formulated with bile acids (e.g., taurocholic acid, glycocholic acid, cholic acid, chenodeoxycholic acid, deoxycholic acid, or lithocholic acid).
• the invention features a method of treating a subject (e.g., a human) having a metabolic disorder.
• the method includes administering an effective amount of a lipid or lipids of the first aspect (e.g., any composition described herein) to the subject.
• the metabolic disorder may be selected from the group consisting of type I diabetes, type II diabetes, maturity-onset diabetes of the young (MODY), gestational diabetes, obesity, satiety, and endocrine deficiencies of aging.
• the invention features a method of treating a subject (e.g., a human) having inflammatory bowel disease. The method includes administering an effective amount of a lipid(s) of the first aspect (e.g., any composition described herein) to the subject.
• the invention features a method of reducing blood glucose levels in a subject (e.g., a human).
• the method includes administering an effective amount of a lipid(s) of the first aspect (e.g., any composition described herein) to the subject.
• the subject may be hyperglycemic.
• the invention features a method of increasing LRH-I receptor activity in a subject (e.g., a human), the method including administering to the subject an effective amount of a lipid(s) of the first aspect (e.g., any composition described herein).
• the lipid or lipid composition may be administered to the subject by any method known in the art (e.g., those described herein).
• the composition is administered by a route selected from the group consisting of oral, rectal, parenteral (e.g., intravenously or intramuscularly), cutaneous, topical, nasal, vaginal, inhalant, skin (patch), and ocular.
• enriched is meant that a compound or substance is present in a composition at a level greater than found in nature, if the composition is naturally occurring.
• a compound or substance may be enriched when it is present in an amount of at least 0.01 %, 0.05%, 0.1 %, 0.5%, 1 %, 1.5%, 2%, 3%, 4%, 5%, 8%, 10%, 12%, 15%, 20%, 25%, 35%, 40%, 50%, 60%, 75%, 80%, 85%, 90%, 92%, 95%, 96%, 97%, 98%, 99%, or 100% of the total weight, or any range between these values, of the composition in which it is provided.
• treating is meant ameliorating at least one symptom of a condition or disease in a subject having the condition or disease (e.g., a subject diagnosed with a metabolic disorder), as compared with an equivalent untreated control.
• Such reduction in the symptom e.g., a reduction in blood glucose levels
• treating prophylactically is meant to reduce the frequency of disease occurrence or severity of disease upon its onset by administering to the subject a therapeutic prior to onset of the disease.
• Prophylactic treatment can include disease prevention.
• Subjects at higher risk of developing metabolic disorders or IBD e.g., risk factors described herein
• IBD inflammatory bowel disease
• inflammatory bowel disease is meant an inflammatory condition of the small or large intestine.
• the major types of inflammatory bowel disease (IBD) are Crohn's disease and ulcerative colitis.
• Other forms of IBD include collagenous colitis, lymphocytic colitis, ischemic colitis, diversion colitis, Behcet's syndrome, infective colitis, and indeterminate colitis.
• a metabolic disorder any pathological condition resulting from an alteration in a subject's metabolism. Such disorders include those resulting from an alteration in glucose homeostasis resulting, for example, in hyperglycemia.
• an alteration in glucose levels is typically an increase in glucose levels by at least 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or even 100% relative to such levels in a healthy individual.
• Metabolic disorders include obesity and diabetes (e.g., diabetes type I, diabetes type II, MODY, and gestational diabetes), satiety, and endocrine deficiencies of aging.
• reducing glucose levels is meant reducing the level of glucose by at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, or 100% relative to an untreated control.
• glucose levels are reduced to normoglycemic levels, i.e., between 150 to 60 mg/dL, between 140 to 70 mg/dL, between 130 to 70 mg/dL, between 125 to 80 mg/dL, and preferably between 120 to 80 mg/dL.
• Such reduction in glucose levels may be obtained by increasing any one of the biological activities associated with the clearance of glucose from the blood. Accordingly, an agent having the ability to reduce glucose levels may increase insulin production, secretion, or action.
• Insulin action may be increased, for example, by increasing glucose uptake by peripheral tissues and/or by reducing hepatic glucose production.
• the agent of the invention may reduce the absorption of carbohydrates from the intestines, alter glucose transporter activity (e.g., by increasing GLUT4 expression, intrinsic activity, or translocation), increase the amount of insulin-sensitive tissue (e.g., by increasing muscle cell or adipocyte cell differentiation), or alter gene transcription in adipocytes, liver, or muscle cells (e.g., altered secretion of factors from adipocytes expression of metabolic pathway genes).
• the agent of the invention increases more than one of the activities associated with the clearance of glucose.
• an amount sufficient is meant an amount of a compound required to treat, treat prophylactically, or reduce disease or disorder (e.g., a metabolic disorder, such as diabetes, or IBD) in a clinically relevant manner.
• a sufficient amount of an active compound used to practice the present invention for therapeutic treatment of conditions caused by or contributing to diabetes varies depending upon the manner of administration, the age, body weight, and general health of the subject. Ultimately, the prescribers will decide the appropriate amount and dosage regimen.
• subject is meant a human or non-human animal (e.g., a mammal).
• increase is meant an amount greater by at least 5%, 10%, 25%, 50%, 100%, 150%, 200%, 500%, or 1000%.
• control subject is meant a healthy subject or a subject not suffering from the disease or condition.
• Figure 1 is a set of diagrams showing generic phospholipid structures.
• Figures 2A and 2B are graphs showing luciferase activity from HeLa cells transfected with a human LRH-I (hLRH-1) expression vector and treated with the indicated phosphotidylcholines (PC). Controls (vector only and no lipid) are as indicated.
• the luciferase assay reporter carrying multiple LRH-I binding sites (SF-I Luc) has been described previously (Ikeda et al., MoI Endocrinol 7:852-60, 1993).
• Cells were treated with 100 ⁇ M of the indicated PCs and luciferase expression (RLU, relative light units) was normalized using an internal ⁇ -galactosidase control, vec, empty vector; -, ethanol solvent control.
• Figures 3A-3D are a set of graphs showing specific hLRH-1 activation by medium length PCs.
• Figure 3A shows that the mouse SHP promoter is activated by hLRH-1 and PCs.
• a 1080 bp portion of the 5'-flanking promoter region of the mSHP gene was linked to a luciferase reporter gene.
• HeLa cells were transfected with an hLRH-1 expression vector along with mSHPiogo-Luc reporter.
• FIG. 3B shows activation of the Oct4-PP by hLRH-1 and DUPC/DLPC.
• COS-I cells were transfected with an hLRH-1 expression vector along with luciferase reporter gene containing the proximal promoter region (-417 to +35) of Oct4 gene (Oct4-PP Luc).
• Oct4-PPmut Luc is identical to Oct4-PP Luc except for the insertion of point mutations in the DRO element.
• FIG. 3C shows DUPC and DLPC selectively activate LRH-I and SF-I .
• HeLa cells were cotransfected with various nuclear receptors and the reporter plasmid (RE-tk-luc). Cells were treated with either 100 ⁇ M DUPC or DLPC. Luciferase expression was assayed and normalized by ⁇ -galactosidase expression. Data are expressed for each reporter as fold activation of normalized luciferase activity relative to veh-treated cells.
• Figure 3D shows DUPC/DLPC dose response for activation of a reporter gene by hLRH-1 in HeLa cells.
• Transfections were performed with 1 , 10, 50, 100, 150, 200, or 250 ⁇ M of the indicated compounds and various NR5A expression vectors.
• EC 50 values were estimated to be 57 ⁇ M (DUPC) and 99 ⁇ M (DLPC) for hLRH-1.
• Figures 4A and 4B are a set of graphs and a photograph showing that DUPC and DLPC promote association of hLRH-1 and SRC-3 in vivo and in vitro.
• Figure 4A shows results from a mammalian two-hybrid assay performed in HeLa cells with VP 16 alone or VP16-hLRHl LBD along with Gal4-SRC3 receptor interaction domain (RID) in the presence of a Gal4 reporter (G5-tk-luc) and the indicated compounds. Data are expressed as fold activation of normalized luciferase activity relative to veh alone.
• Figure 4B shows the GST pulldown assay was performed with GST alone or GST-hLRH-1 LBD along with in vitro translated coactivator [ 35 S]Met-SRC3 in the presence of 100 ⁇ M of the indicated compounds.
• CB coomassie blue staining.
• Figures 5 A-5C are a photograph and a set of graphs showing that increased LRH-I activity is dependent on hLRH-1 and DUPC/DLPC.
• Figure 5 A shows Western blot analysis with anti-hLRH-1 antibody to confirm endogenous hLRH-1 knockdown using siRNA.
• C3A HepG2 cells (derivatives of HepG2) were transfected with either non-targeting siRNA control or siRNA hLRH-1.
• Figure 5B shows compromised LRH-I Luc promoter activity in siRNA hLRH-1 transfected C3A HepG2 cells. Increased LRH-I Luc promoter activity is dependent on hLRH-1 and DUPC/DLPC in C3A HepG2.
• Figures 6A-6C are a set of graphs showing an animal study with DUPC/DLPC.
• Figure 6A shows results from 8-week-old wild type male mice challenged orally with vehicle (ethanol in a 4:1 mixture of PEG-400 and Tween-80), CA, DPPC, DUPC, and DLPC (100 mg/kg body weight) five times in morning and evening over three days.
• Figure 6C shows total, serum, and hepatic bile acids, and serum glucose and NEFA measured in the same control and treated animals. *P ⁇ 0.05 vs wt-veh.
• Figures 8A-8D are graphs showing improved diabetic conditions in mice upon administration of DLPC.
• Glucose tolerance GTT: 1.5g/kg i.p.
• ITT insulin tolerance
• Figure 8B shows serum insulin, BAs, cholesterol, TG, and NEFA in the same control and treated animals.
• Figure 8C shows hepatic TG, cholesterol, and NEFA in the same control and treated animals.
• Figure 8D shows mRNA levels of lipogenic genes in the same control and treated animals.
• Figure 9 is a set of graphs showing that the antidiabetic effects of DLPC are LRH-I dependent. 8-10 week-old male LRH-I f/f littermates were injected with either Ad-GFP or Ad-Cre. Starting 2 weeks after infection, mice were fed a 45% high fat diet for 15 weeks. Continuing on the diet, they were treated by daily oral gavage with vehicle, DPPC or DLPC for last 2 weeks, and glucose homeostasis was assessed with a standard glucose tolerance test. *P ⁇ 0.05, **P ⁇ 0.01 vs veh.
• PC lipids having 22-24 carbons in their fatty acid tails e.g., diundecanoyl (Cl 1 :0-Cl 1 :0) and dilauroyl (C12:0-C12:0) phosphatidylcholine (DUPC and DLPC, respectively) are capable of acting as agonists of the LRH-I receptor.
• the present invention features compositions and methods useful in the treatment of metabolic disorders and inflammatory bowel disease.
• Phosphatidylcholine lipids e.g., diundecanoyl (Cl 1 :0-Cl 1 :0) and dilauroyl (C12:0-C12:0) phosphatidylcholine (DUPC and DLPC, respectively) are capable of acting as agonists of the LRH-I receptor.
• the lipids used in the compositions and methods of the invention have 22-24 carbon atoms in their fatty acid tails, where typically each tail has 10, 1 1 , 12, or 13 carbon atoms.
• DUPC and DLPC which are phosphatidylcholine compounds having 1 1 and 12 carbon atoms, respectively, in each of the fatty acid tails on the molecules.
• General phospholipid structures are shown in Figure 1.
• DUPC has the structure:
• DLPC has the structure:
• PC lipids include Cl 1 :0, C12:0 undecanoyl, lauroyl PCs in particular, as well as Cl 1 :0, C13:0 undecanoyl, tridecanoyl PCs and C10:0, C12:0 decanoyl, lauroyl PCs.
• compositions of the invention may include one or more of these lipids, which may be present in amount(s) of at least 1, 5, 10, 25, 50, 100, 250, 500, or 750 ⁇ g; at least 1 , 2, 5, 10, 25, 50, 100, 250, 500, or 750 mg; or at least 1, 2, 5, 10, 15, 20, 25, 50, or 100 g, or any range between these values.
• the compositions may include at least 0.01%, 0.05%, 0.1%, 0.5%, 1%, 2%, 3%, 5%, 8%, 10%, 15%, 20%, 25%, 40%, 50%, 60%, 75%, 85%, 90%, 95%, 98%, or 99% of the lipid(s), or any range between these values.
• the compositions include less than 99%, 98%, 95%, 90%, 85%, 75%, 60%, 50%, 40%, 25%, 20%, 15%, 8%, 5%, 3%, 2%, 1%, or 0.5% of the lipid(s).
• the ratio between any two of the lipids present may be at least 1000: 1 , 500: 1 , 100:1 , 50:1 , 25: 1 , 10:1, 5:1, 3:1, 2:1, 1 :1, 1 :2, 1 :3, 1 :5, 1 :10, 1 :25, 1 :50, 1 :100, 1 :500, or 1 :1000, or any range between these values.
• compositions of the invention may be in any of the forms described herein.
• the composition is food that has been enriched with one or more of these lipids.
• these lipids, or compositions containing these lipids can be used to treat metabolic disorders (e.g., diabetes and obesity) and inflammatory bowel disease.
• NR5A nuclear receptors are a highly conserved subgroup of the nuclear receptor superfamily, with clear orthologs in Drosophila (FtzFl, NR5A4) (Lavorgna et al. Science 252:848-51 , 1991 ; Broadus et al. MoI Cell 3:143-9, 1999), zebrafish (fflb, NR5A3), and many other species.
• Mammalian NR5A2 was independently isolated by several groups and has been given multiple names (Nitta et al. Proc Natl Acad Sci U S A 96:6660-5, 1999; Becker-Andre et al. Biochem Biophys Res Commun 194: 1371-9, 1993; Galarneau et al.
• LRH- 1 Liver Receptor Homolog-1
• SF-I SF-I
• LRH-I shows a strong interaction with the orphan receptor SHP (NR0B2), which acts as a corepressor (Goodwin et al. MoI Cell 6:517-26, 2000; Lu et al. MoI Cell 6:507-15, 2000; Lee et al. J Biol Chem 277:2463-7, 2002).
• Crystal structure analysis defined the interaction between LRH-I and LxxLL motifs in SHP and explained the preference of SHP for interaction over other coregulators (Ortlund et al. Nat Struct MoI Biol 12:357-63, 2005; Li et al. Proc Natl Acad Sci U S A 102:9505-10, 2005).
• SHP is an important negative regulator of LRH-I activity.
• the transcriptional activity of LRH-I is modulated by posttranslational modification.
• the two major modifications identified are sumoylation (Chalkiadaki et al. MoI Cell Biol 25:5095-105, 2005) and phosphorylation (Lee et al. J Biol Chem 281 :7850-5, 2006), which have opposite effects.
• SUMO modification of the hinge region localizes LRH- 1 to promyelocyte leukemia protein (PML) nuclear bodies, excluding the transcription factor from active chromatin (Chalkiadaki et al.
• LRH-I The first suggested physiological role of LRH-I was in expression of ⁇ i- fetoprotein, an albumin gene family member that is a marker of endodermal specification during early liver development (Galarneau et al. MoI Cell Biol 16:3853- 65, 1996).
• ⁇ i- fetoprotein an albumin gene family member that is a marker of endodermal specification during early liver development
• a broader association with endodermal differentiation emerged from the reciprocal observations that the mouse LRH-I gene promoter has binding sites for transcription factors important for endodermal determination and hepatic differentiation, such as GATA, Nkx, and HNF4 ⁇ , and that LRH-I in turn contributes to expression of genes encoding transcription factors critical to early hepatic differentiation, such as Hnf3 ⁇ /FoxA2, HNF4 ⁇ , and Hnfl ⁇ (Pare et al. J Biol Chem 276:13136-44, 2001).
• LRH-I Another very early developmental function of LRH-I is its ability to activate expression of Oct4, which is required to maintain pluripotence at the earliest stages of both embryonic development and ES cell differentiation (Gu et al. MoI Cell Biol 25:3492-505, 2005).
• the importance of LRH-I in the initial stages of development is suggested by its broad expression in the early embryo and confirmed by the very early embryonic lethalilty of homozygous LRH-I knockout mice (Botrugno et al. MoI Cell 15:499-509, 2004; Gu et al. MoI Cell Biol 25:3492-505, 2005; Pare et al. J Biol Chem 279:21206-16, 2004).
• LRH-I mRNA is relatively abundant in ovary (Bookout et al. Cell 126:789-99,
• Aromatase which converts androgens into estrogens
• P450 scc side chain cleavage enzyme
• LRH-I target genes suggesting a regulatory role for LRH-I in ovarian steroidogenesis (Clyne et al. J Biol Chem 277:20591-7, 2002; Kim et al. J Clin Endocrinol Metab 90: 1678-85, 2005).
• LRH-I cholesterol-7 ⁇ hydroxylase
• Cyp7Al gene expression was increased, rather than decreased as expected in heterozygous LRH-I null mice (Pare et al. J Biol Chem 279:21206-16, 2004; del Castillo-Olivares et al. J Biol Chem 279:16813-21, 2004), and was also decreased at later time points (3-5 days) after adenoviral LRH-I overexpression (Delerive et al. MoI Endocrinol 18:2378-87, 2004).
• LRH-I As a positive regulator of expression of the orphan receptor SHP (Lee et al. J Biol Chem 274:20869-20873, 1999) can explain at least some of these discrepancies.
• LRH-I (Lee et al. J Biol Chem 274:20869-20873, 1999) combines with the bile acid receptor FXR (Goodwin et al. MoI Cell 6:517-26, 2000; Lu et al. MoI Cell 6:507-15, 2000) to activate SHP expression when bile acid levels are elevated.
• this "simple" LRH-I-FXR-SHP loop is only one of several regulatory inputs in the increasingly complex area of bile acid homeostasis.
• SHP is also required for the negative regulation of Cyp7Al expression in response to fibroblast growth factor 15/19 activation of its receptor FGFR4 (Inagaki et al. Cell Metab 2:217-25, 2005).
• FXR activation in the gut results in increased FGF- 15/19 expression and decreased hepatic bile acid production.
• Cyp7Al expression was unaltered, not decreased as expected, apparently as a consequence of the concomitant decrease in SHP expression and/or input of other regulatory pathways. Instead, the major alteration in bile acid enzymes was a nearly complete loss of expression of another LRH-I target (del
• LRH-I has also been reported to directly regulate hepatic or intestinal expression of a number of additional enzymes and transporters involved in cholesterol and bile acid metabolism, including cholesteryl ester transfer protein (CETP), scavenger receptor class B type I (SR-BI), apical sodium-dependent bile acid transporter (ASBT), and apolipoprotein AI (ApoAI) (Schoonjans et al. EMBO Rep 3:1181-7, 2002; Delerive et al. MoI Endocrinol 18:2378-87, 2004; del Castillo- Olivares et al. J Biol Chem 275: 17793-9, 2000; Inokuchi et al.
• CETP cholesteryl ester transfer protein
• SR-BI scavenger receptor class B type I
• ASBT apical sodium-dependent bile acid transporter
• AdoAI apolipoprotein AI
• cholesteryl esters from HDL in plasma can be transferred to apolipoprotein B-containing lipoproteins to form VLDL by CETP, and taken up by the liver through LDL receptors.
• CETP apolipoprotein B-containing lipoproteins
• LDL receptors LDL receptors
• the lipids and compositions containing these lipids described herein may be used to treat (e.g., prophylactically treat) metabolic disorders. These methods are particularly useful for treating subjects having or at risk of having any condition that is characterized by a state of hyperglycemia, which may be caused, for example, by an alteration in the insulin signaling pathway (e.g., a reduction in insulin production, resistance to insulin, or both).
• Exemplary disorders amenable to treatment according to this invention are obesity, diabetes (e.g., type 1 diabetes, type 2 diabetes, maturity- onset diabetes of the young (MODY), and gestational diabetes), satiety, endocrine deficiencies of aging, and any of their associated complications (e.g., Syndrome X, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, peripheral vascular disease, hyperlipidemia, hypertension, atherosclerosis, and coronary heart disease).
• diabetes e.g., type 1 diabetes, type 2 diabetes, maturity- onset diabetes of the young (MODY), and gestational diabetes
• satiety e.g., endocrine deficiencies of aging, and any of their associated complications (e.g., Syndrome X, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, peripheral vascular disease, hyperlipidemia, hypertension, atherosclerosis, and coronary heart disease).
• the lipids and compositions containing these lipids are useful for treating a subject that has been diagnosed with, or is at risk of having a metabolic disorder, such as diabetes (e.g., type I or type II diabetes).
• a metabolic disorder such as diabetes (e.g., type I or type II diabetes).
• a subject in whom the development of a metabolic disorder (e.g., diabetes or obesity) is being treated prophylactically (e.g., prevented) may or may not have received such a diagnosis.
• a metabolic disorder e.g., diabetes or obesity
• prophylactically e.g., prevented
• subjects may have been tested using standard tests or may have been identified, without examination, as one at high risk due to the presence of one or more risk factors (e.g., those described herein).
• Diagnosis of metabolic disorders may be performed using any standard method known in the art, such as those described herein. Methods for diagnosing diabetes are described, for example, in U.S. Patent No. 6,537,806, hereby incorporated by reference. Diabetes may be diagnosed and monitored using, for example, urine tests (urinalysis) that measure glucose and ketone levels (products of the breakdown of fat); tests that measure the levels of glucose in blood; glucose tolerance tests; and assays that detect molecular markers characteristic of a metabolic disorder in a biological sample (e.g., blood, serum, or urine) collected from the mammal (e.g., measurements of hemoglobin AIc (HbAIc) levels in the case of diabetes).
• a biological sample e.g., blood, serum, or urine
• HbAIc hemoglobin AIc
• Subjects may be diagnosed as being at risk or as having diabetes if a random plasma glucose test (taken at any time of the day) indicates a value of 200 mg/dL or more, if a fasting plasma glucose test indicates a value of 126 mg/dL or more (after 8 hours), or if an oral glucose tolerance test (OGTT) indicates a plasma glucose value of 200 mg/dL or more in a blood sample taken two hours after a person has consumed a drink containing 75 grams of glucose dissolved in water.
• the OGTT measures plasma glucose at timed intervals over a 3-hour period.
• the level of plasma glucose in a diabetic subject that has been treated according to the invention ranges between 160 to 60 mg/dL, between 150 to 70 mg/dL, between 140 to 70 mg/dL, between 135 to 80 mg/dL, and preferably between 120 to 80 mg/dL.
• HbAIc hemoglobin AIc
• a person without diabetes typically has an HbAIc value that ranges between 4% and 6%.
• HbAIc value of a subject being treated according to the present invention is reduced to less than 9%, less than 7%, less than 6%, and most preferably to around 5%.
• the HbAIc levels of the subject being treated are preferably lowered by 10%, 20%, 30%, 40%, 50%, or more relative to such levels prior to treatment.
• Gestational diabetes is typically diagnosed based on plasma glucose values measured during the OGTT. Since glucose levels are normally lower during pregnancy, the threshold values for the diagnosis of diabetes in pregnancy are lower than in the same person prior to pregnancy. If a woman has two plasma glucose readings that meet or exceed any of the following numbers, she has gestational diabetes: a fasting plasma glucose level of 95 mg/dL, a 1 -hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL. Ketone testing may also be employed to diagnose type 1 diabetes. Because ketones build up in the blood when there is not enough insulin, they eventually accumulate in the urine. High levels of blood ketones may result in a serious condition called ketoacidosis.
• HbAIc hemoglobin AIc
• Subjects may be determined to be at high risk of developing a metabolic disorder due to the presence of one or more risk factors, such as family history, obesity, particular ethnicity (e.g., African Americans and Hispanic Americans), gestational diabetes or delivering a baby that weighs more than nine pounds, hypertension, having a pathological condition predisposing to obesity or diabetes, high blood levels of triglycerides, high blood levels of cholesterol, presence of molecular markers (e.g., presence of autoantibodies), and age (over 45 years of age).
• An individual is considered obese when their weight is 20% (25% in women) or more over the maximum weight desirable for their height.
• An adult who is more than 100 pounds overweight, is considered to be morbidly obese.
• Obesity is also defined as a body mass index (BMI) over 30 kg/m 2 .
• IBD inflammatory bowel disease
• Other forms of IBD include collagenous colitis, lymphocytic colitis, ischemic colitis, diversion colitis, Behcet's syndrome, infective colitis, and indeterminate colitis.
• Loss of one copy of LRH-I substantially increases susceptibility of mice to pathologic effects in the well studied mouse models of IBD based on treatments with either 2,4,6-trinitrobenzene sulfonic acid (TNBS) or the milder dextran sodium sulfate (DSS), and DSS induces particularly severe colitis in gut specific LRH-I 7" mice (Coste et al., Proc Natl Acad Sci USA 104:13098-103, 2007).
• TNBS 2,4,6-trinitrobenzene sulfonic acid
• DSS milder dextran sodium sulfate
• LRH-I drives expression of the steroidogenic P450s Cypl 1 Al (cholesterol side-chain cleavage enzyme) and Cypl IBl (steroid 1 1 - ⁇ -monooxygenase) in the intestinal mucosa following inflammatory stimuli such as treatments with T cell activating anti- CD3 antibody, which induces LRH-I expression (Mueller et al.
• both total LRH-I 7+ heterozygous mice and villin ere generated gut specific LRH-I 7' knockouts show decreased corticosterone production and increased levels of the inflammatory cytokines IL- l ⁇ and IL-6 in the 2,4,6- trinitrobenzene sulfonic acid (TNBS) induced mouse model of inflammatory bowel disease (Coste et al., Proc Natl Acad Sci USA 104:13098-103, 2007). As expected, this is associated with increased pathologic effects, including edema, neutrophil infiltration, and necrosis.
• TNBS 2,4,6- trinitrobenzene sulfonic acid
• LRH-I agonists such as DUPC and DLPC, can be used to treat (e.g., treat prophylactically) this disorder.
• lipid or lipids described herein or a composition containing one or more of these lipids may be by any suitable means that results in a concentration of the compound that treats a metabolic disorder or IBD.
• the lipid may be in any appropriate amount of any suitable carrier substance, and is generally present in an amount of 1-95% by weight of the total weight of the composition.
• the composition may be provided in a dosage form that is suitable for the oral, parenteral (e.g., intravenously or intramuscularly), rectal, cutaneous, nasal, vaginal, inhalant, skin (patch), topical, ocular, or intracranial administration route.
• the composition may be in the form of, e.g., tablets, capsules, pills, powders, granulates, suspensions, emulsions, solutions, gels including hydrogels, pastes, ointments, creams, plasters, drenches, osmotic delivery devices, suppositories, enemas, injectables, implants, sprays, or aerosols.
• the pharmaceutical compositions may be formulated according to conventional pharmaceutical practice (see, e.g., Remington: The Science and Practice of Pharmacy, 20th edition, 2000, ed. A. R. Gennaro, Lippincott Williams & Wilkins, Philadelphia, and Encyclopedia of Pharmaceutical Technology, eds. J. Swarbrick and J. C. Boylan, 1988-1999, Marcel Dekker, New York).
• compositions may be formulated to release the lipid(s) immediately upon administration or at any predetermined time or time period after administration.
• controlled release formulations include (i) formulations that create substantially constant concentrations of the lipid(s) within the body over an extended period of time; (ii) formulations that after a predetermined lag time create substantially constant concentrations of the lipid(s) within the body over an extended period of time; (iii) formulations that sustain the lipid(s) action during a predetermined time period by maintaining a relatively constant, effective level of the lipid(s) in the body with concomitant minimization of undesirable side effects associated with fluctuations in the plasma level of the lipid(s) (sawtooth kinetic pattern); (iv) formulations that localize action of lipid(s), e.g., spatial placement of a controlled release composition adjacent to or in the diseased tissue or organ; (v) formulations that achieve convenience of dosing, e.g., administering the composition once per week or
• controlled release is obtained by appropriate selection of various formulation parameters and ingredients, including, e.g., various types of controlled release compositions and coatings.
• the lipid(s) is formulated with appropriate excipients into a pharmaceutical composition that, upon administration, releases the lipid(s) in a controlled manner. Examples include single or multiple unit tablet or capsule compositions, oil solutions, suspensions, emulsions, microcapsules, molecular complexes, microspheres, nanoparticles, patches, and liposomes.
• Formulations for oral use include tablets containing the lipid(s) in a mixture with non-toxic pharmaceutically acceptable excipients, and such formulations are known to the skilled artisan (e.g., U.S.P.N.: 5,817,307, 5,824,300, 5,830,456, 5,846,526, 5,882,640, 5,910,304, 6,036,949, 6,036,949, 6,372,218, hereby incorporated by reference).
• excipients may be, for example, inert diluents or fillers (e.g., sucrose, sorbitol, sugar, mannitol, microcrystalline cellulose, starches including potato starch, calcium carbonate, sodium chloride, lactose, calcium phosphate, calcium sulfate, or sodium phosphate); granulating and disintegrating agents (e.g., cellulose derivatives including microcrystalline cellulose, starches including potato starch, croscarmellose sodium, alginates, or alginic acid); binding agents (e.g., sucrose, glucose, sorbitol, acacia, alginic acid, sodium alginate, gelatin, starch, pregelatinized starch, microcrystalline cellulose, magnesium aluminum silicate, carboxymethylcellulose sodium, methylcellulose, hydroxypropyl methylcellulose, ethylcellulose, polyvinylpyrrolidone, or polyethylene glycol); and lubricating agents, glidants, and anti-a
• Other pharmaceutically acceptable excipients can be colorants, flavoring agents, plasticizers, humectants, buffering agents, and the like.
• the tablets may be uncoated or they may be coated by known techniques, optionally to delay disintegration and absorption in the gastrointestinal tract and thereby providing a sustained action over a longer period.
• the coating may be adapted to release the lipid(s) in a predetermined pattern (e.g., in order to achieve a controlled release formulation) or it may be adapted not to release the lipid(s) until after passage of the stomach (enteric coating).
• the coating may be a sugar coating, a film coating (e.g., based on hydroxypropyl methyl cellulose, methyl cellulose, methyl hydroxyethylcellulose, hydroxypropylcellulose, carboxymethylcellulose, acrylate copolymers, polyethylene glycols, and/or polyvinylpyrrolidone), or an enteric coating (e.g., based on methacrylic acid copolymer, cellulose acetate phthalate, hydroxypropyl methylcellulose phthalate, hydroxypropyl methylcellulose acetate succinate, polyvinyl acetate phthalate, shellac, and/or ethylcellulose).
• a time delay material such as, e.g., glyceryl monostearate or glyceryl distearate, may be employed.
• the solid tablet compositions may include a coating adapted to protect the composition from unwanted chemical changes (e.g., chemical degradation prior to the release of the active substances).
• the coating may be applied on the solid dosage form in a similar manner as that described in Encyclopedia of Pharmaceutical Technology, supra.
• compositions of the invention may be mixed together in the tablet, or may be partitioned.
• a first agent is contained on the inside of the tablet, and a second agent is on the outside, such that a substantial portion of the second agent is released prior to the release of the first agent.
• Formulations for oral use may also be presented as chewable tablets, or as hard gelatin capsules wherein the lipid(s) is mixed with an inert solid diluent (e.g., potato starch, lactose, microcrystalline cellulose, calcium carbonate, calcium phosphate, or kaolin), or as soft gelatin capsules wherein the lipid(s) is mixed with water or an oil medium, for example, peanut oil, liquid paraffin, or olive oil.
• Powders and granulates may be prepared using the ingredients mentioned above under tablets and capsules in a conventional manner using, e.g., a mixer, a fluid bed apparatus, or spray drying equipment.
• the dosage of lipid(s) contained in a composition described herein or used in the methods described herein depends on several factors, including: the administration method, the disorder to be treated, the severity of the disorder, whether the disorder is to be treated or prevented, and the age, weight, and health of the subject to be treated.
• an adult human subject may receive between 0.1 and 100 g/day (e.g., about 0.1, 0.2, 0.5, 1.0, 2.0, 3.0, 4.0, 5.0, 6.0, 7.0, 8.0, 9.0, 10, 12, 15, 20, 30, 40, 50, 60, 70, 80, 90, or 100 g/day) of the lipid or combination of lipids (e.g., 1- 10 g/day).
• a compound to a subject be limited to a particular mode of administration, dosage, or frequency of dosing; the present invention contemplates all modes of administration, including intramuscular, intravenous, intraperitoneal, intravesicular, intraarticular, intralesional, subcutaneous, or any other route sufficient to provide a dose adequate to treat a metabolic disorder or IBD, to decrease blood glucose levels, or to increase LRH-I receptor activation.
• the compound may be administered to the subject in a single dose or in multiple doses.
• a compound described herein or identified using screening methods of the invention may be administered once a week for, e.g., 2, 3, 4, 5, 6, 7, 8, 10, 15, 20, or more weeks.
• the dosage of a compound can be increased if the lower dose does not provide sufficient activity in the treatment of a metabolic disorder (e.g., diabetes or obesity). Conversely, the dosage of the compound can be decreased if the metabolic disorder is reduced or eliminated.
• a metabolic disorder e.g., diabetes or obesity
• a therapeutically effective amount of a DUPC or DLPC may be, for example, in the range of 0.0035 ⁇ g to 1 g/kg body weight/day or 0.010 ⁇ g to 100 mg/kg body weight/week.
• a therapeutically effective amount is in the range of 0.025 ⁇ g to 10 mg/kg body weight administered daily, every other day, or twice a week.
• a therapeutically effective amount may be in the range of 0.05 ⁇ g to 20 mg/kg, for example, at least 0.05, 0.1, 0.15, 0.2, 1, 2, 3, 5, 8, 10, 25, 50, 100, 200, or 500 ⁇ g/kg or 1, 2, 5, 8, 10, 15, or 20 mg/kg body weight administered one, two, three, or four times a day, one, two, three, or four times weekly, every other week, or once a month.
• Example 1 Identification of LRH-I agonists
• PC phosphatidylcholine
• Figure 2A This was confirmed in more focused analysis of shorter saturated chain lengths. This analysis also showed responses to DLPC, as well as to 0-Cl 1 :0 diundecanoyl PC (DUPC) ( Figure 2B).
• LRH-I In contrast to the prediction from the crystal structures, mouse and human LRH-I show essentially equivalent responses to DUPC and DLPC. Both DUPC and DLPC also activate SF-I, with a response very similar to that of LRH-I . This activation is substantially greater than that observed with the recently described ligand C14:0-C14:0 PA (Li et al. MoI Cell Biol, 27:6669-6685, 2007), which increased SF-I transactivation by only 1.2-1.4 fold in our hands and, as reported, had no effect on LRH-I transactivation (Figure 3C).
• the EC 5 o values for DUPC and DLPC activation of human LRH-I are approximately 60 and 100 ⁇ M ( Figure 3D), and similar values were obtained for mouse LRH-I and SF-I . While these concentrations are much higher than the estimated 100 nM affinity of SF-I for C14:0-C14:0 PA (Li et al. MoI Cell Biol, 27:6669-6685, 2007), numerous issues including solubility, cell permeability and intracellular transport and turnover leave it impossible to directly compare the in vitro and cell based studies.
• phosphatidylcholine species with total fatty acid chain lengths of between the 22 carbons of DUPC and the 24 carbons of DLPC will also act as LRH-I agonists.
• compounds having 10, 1 1 , 12, or 13 fatty acid chain lengths will be particularly useful. These compounds include, in particular, the Cl 1 :0, C12:0 undecanoyl, lauroyl PCs, as well as the Cl l :0, C13:0 undecanoyl, tridecanoyl PCs and the C10:0, C12:0 decanoyl, lauroyl PCs.
• Liver bile acids appeared somewhat lower in DUPC and DLPC treated mice, but did not show statistically significant changes even in the CA fed mice, indicating the maintenance of overall hepatocyte bile acid homeostasis. Consistent with the activation of protective responses such as bile acid export from the liver, serum bile acid levels were substantially elevated by DUPC, DLPC, and CA ( Figure 6C). We (Ma et al. J Clin Invest 1 16: 1102-9, 2006) and others (Zhang et al. Proc Natl Acad Sci USA 103:1006-1 1, 2006; Cariou et al.
• DPPC treatment resulted in a lesser beneficial response in the GTT, but not the ITT.
• This effect was not anticipated, but is consistent with the demonstration of decreased total PC levels in human patients with non-alcoholic fatty liver disease or steatohepatitis (Pun et al. Hepatology 46:1081-90, 2007), with a report that dietary PC (egg derived, mainly Cl 6:0, Cl 8:1, and Cl 8:2) nearly completely blocks the induction of fatty liver by the uridine precursor orotic acid (Buang et al. Nutrition 21 : 867-73, 2005), and also with an older study indicating that dietary PC decreases hepatic triglycerides in normal rats (Imaizumi et al.
• LRH-I gene were treated with GFP containing or Cre containing adenovirus. Only mice having the LRH-I gene showed reductions in serum glucose levels upon administration of DLPC ( Figure 9).

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